No abstract available.
Dinoprostone* ; Suppositories*

Although congenital syphilis can be prevented with prenatal screening, the disease remains problematic. Currently, there are no cases that describe hematuria and pneumonia related to congenital syphilis. We report a case of congenital syphilis that involved nephrotic syndrome and pneumonia alba in a 22-day-old male infant whose mother did not receive adequate prenatal care. The congenital syphilis diagnosis was confirmed with a serologic test and the patient recovered with penicillin treatment. Clinical findings may be subtle in neonates and delayed recognition occurs frequently, thus complete prenatal screening is critical for congenital syphilis prevention. Immediate serologic testing should be performed to obtain a differential diagnosis if an infant is delivered by a mother that has not received appropriate prenatal examinations.
Diagnosis ; Diagnosis, Differential ; Exanthema* ; Hematuria* ; Humans ; Infant ; Infant, Newborn ; Male ; Mothers ; Nephrotic Syndrome ; Penicillins ; Pneumonia* ; Prenatal Care ; Prenatal Diagnosis ; Serologic Tests ; Syphilis, Congenital*

Korea has a relatively short history in the development and use of clinical practice guidelines (CPGs). Additionally, it has been difficult to employ the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument due to the lack of consensus and the presence of differences in Korean medical settings and in the Korean socio-cultural environment. An AGREE II scoring guide was therefore developed to reduce differences among evaluators using the same tool. In consideration of the importance of using a quantitative measure of satisfaction with the elements described in the AGREE II manual, a final draft was developed through a Delphi consensus process. Ninety-two draft scoring guides for anchor points 1, 3, 5, and 7 (full score) in 23 items were developed. Consensus was defined as agreement among at least 70% of the raters. Agreement on 88 draft scoring guidelines was reached in the first Delphi round, and agreement for the remaining four was achieved in the second round. The development of an AGREE II scoring guide in this study is expected to contribute to improving the CPG environment.
Consensus ; Humans ; Peer Review ; *Practice Guidelines as Topic ; Republic of Korea

PURPOSE: We evaluated the efficacy of core decompression (CD) for treating early avascular necrosis of the femoral head (ANFH), as well as the effect of an autogeneous bone graft and an DBM graft on the results of CD. MATERIALS AND METHODS: This study included 37 patients (40 cases) who were initially diagnosed as suffering with early ANFH, and they were treated with CD and followed up for a minimum of two years. The average patient age was 47.8 years and the average follow up period was 62.4 months., The Ficat & Arlet (F&A) stage and the ARCO stage were used for the radiological staging. RESULTS: The failure rate was 65% (26 case), and 32.5% (13 cases) underwent THA due to clinical and radiological failure. According to the F&A stage, there were 10 stage I hips, 22 stage IIA hips and 8 stage IIB hips, and the success rate (SR) of core decompression was 60%, 36.4% and 0%, respectively. The differences were statistically significant. The cases of ARCO stage II were divided into subgroups: A 2 hips, B 13 hips and C 12 hips and the SR of each were 50%, 46%, and 33.3%, respectively. The differences were statistically significant. CONCLUSION: CD should be carefully considered for treating the advanced stages above F&A stage IIA and ARCO stage IIB.
Artemisinins ; Decompression ; Follow-Up Studies ; Head ; Hip ; Humans ; Naphthoquinones ; Necrosis ; Stress, Psychological ; Tacrine ; Transplants

BACKGROUND: Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women. METHODS: 202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS). RESULTS: The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability. CONCLUSION: In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain.
Ambulatory Care Facilities ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis* ; Coronary Vessels* ; Diagnosis ; Echocardiography, Stress* ; Electrocardiography* ; Exercise Test ; Female ; Head* ; Heart Rate ; Humans ; Ischemia ; Sensitivity and Specificity

Acute generalized exanthematous pustulosis (AGEP) is a rare disease characterized by multiple acute, small, non-follicular, sterile pustules on an erythematous background, usually accompanied by fever and leukocytosis. AGEP is attributed to systemic drugs, mainly beta-lactam and macrolide antimicrobials, in more than 90% of cases. Systemic contact dermatitis is not rare after ingesting lacquer broth, but few reported cases of AGEP have occurred after the ingestion of lacquer chicken broth without a past history of drugs, viral infection, or contact allergy to mercury. Here, we report a rare case of AGEP with a pattern of septic shock induced by the intake of lacquer chicken in a 40-year-old male patient. He developed a generalized pustular lesion with high fever and hypotension. Histologic examination showed subcorneal neutrophilic pustules, papillary dermal edema, and lymphohistiocytic perivascular infiltrates with some eosinophils and neutrophils. The patient was treated with empirical antibiotics and systemic steroids, and the pustular lesions improved 2 weeks later without recurrence.
Acute Generalized Exanthematous Pustulosis ; Adult ; Anti-Bacterial Agents ; Chickens ; Dermatitis, Contact ; Eating ; Edema ; Eosinophils ; Fever ; Humans ; Hypersensitivity ; Hypotension ; Lacquer ; Leukocytosis ; Male ; Neutrophils ; Rare Diseases ; Recurrence ; Shock, Septic ; Steroids

OBJECTIVES: To investigate the perception of and treatment pattern with regard to the four important issues in the management of lupus nephritis (LN), and to identify which parts of the LN treatment are difficult for physicians to carry out in clinical practice. METHODS: Four steps were carried out: pre-survey, LN symposium, post-survey, and meeting after the symposium.The two surveys were conducted with the same contents regarding renal biopsy, induction and maintenance treatment for class III and IV LN, and treatment for class V LN. The results of the first survey and the changes in opinion reflected in the second survey were comparatively analyzed. RESULTS: In the first survey, most of the respondent physicians replied that they would immediately conduct biopsy in the case of significant proteinuria. For the induction treatment of class III and IV LN, most of the respondent physicians selected high-dose cyclophosphamide. Mycophenolate mofetil and steroid combination therapy were selected for the maintenance treatment, and tacrolimus for the treatment of class V LN. There was a controversy in the drug selection, however, especially on the maintenance treatment of class III and IV LN and on the treatment of non-responsive class V LN. CONCLUSION: Some discrepancies were found in the treatment of LN in the real world. Although no recommendation was made for Korean LN patients in this study, the study results will help physicians select the most reasonable treatment for Korean LN patients based on experts' experiences and objective evidence.
Biopsy ; Cyclophosphamide ; Surveys and Questionnaires ; Humans ; Lupus Nephritis ; Mycophenolic Acid ; Proteinuria ; Tacrolimus

PURPOSE: The purpose of this study was to evaluate the problems and the quality of the Internet Web-sites for management of short stature in childhood and adolescent. METHODS: We evaluated 105 Web-sites identified from 5 search engines, Naver, Daum, Korean Yahoo, Nate and Empas, using the word of 'height and/or short stature'. According to Web-site author, total Web-sites were classified as academy & society, physician, commercials, portal site, oriental medicine, and unidentified. We accessed how well the Web-sites informed people about the diseases by of short stature. RESULTS: Of the 105 Web-sites, 98 were accessible. 45 Web-sites (46%) were operated by oriental medicine group. Difference in IS between oriental medicine group and non-oriental medicine groups was significant (P<0.001). CONCLUSION: A great portion of Web-sites on short stature was operating by oriental medicine group. Oriental medicine Web-sites had a tendency to be omitted essential information on short stature and occasionally even had unhealthy information. This investigation could have a adverse influence that internet navigators for short stature might miss a chance of managing in time and there were huge increasing medical expense. There was strongly demand for reliable national certification system to certify to exellent quality for medical and health Web-sites.
Adolescent ; Certification ; Humans ; Internet* ; Medicine, East Asian Traditional ; Search Engine

OBJECTIVE: To determine the relationship between preoperative hypoalbuminemia and the development of complications after gynecological cancer surgery, as well as postoperative bowel function and hospital stay. METHODS: The medical records of 533 patients with gynecological cancer surgery at Konkuk University Hospital between 2005 and 2013 were reviewed. Serum albumin level <3.5 g/dL was defined as hypoalbuminemia. All perioperative complications within 30-days after surgery, time to resumption of normal diet and length of postoperative hospital stay, were analyzed. Regression models were used to assess predictors of postoperative morbidity. RESULTS: The median age was 49 years (range, 13 to 85 years). Eighty patients (15%) had hypoalbuminemia. Hypoalbuminemic patients had significantly higher consumption of alcohol >2 standard drinks per day, lower American Society of Anesthesiologist score, higher frequency of ascites, and more advanced stage compared with non-hypoalbuminemic patients. Overall complication rate within 30-days after surgery was 20.3% (108 out of 533). Hypoalbuminemic patients were more likely to develop postoperative complications compared to non-hypoalbuminemic patients (34.3% vs. 17.8%, P=0.022), and had significantly longer median time to resumption of normal diet (3.3 [1-6] vs. 2.8 [0-15] days, P=0.005) and length of postoperative hospital stay (0 [7-50] vs. 9 [1-97] days, P=0.014). In multivariate analysis, age >50 (odds ratio [OR], 2.478; 95% confidence interval [CI], 1.310 to 4.686; P=0.005), operation time (OR, 1.006; 95% CI, 1.002 to 1.009; P=0.006), and hypoalbuminemia (OR, 2.367; 95% CI, 1.021 to 5.487; P=0.044) were the significant risk factor for postoperative complications. CONCLUSION: Preoperative hypoalbuminemia in patients with elective surgery for gynecologic malignancy is an independent predictor of 30-days postoperative complications. Identification of this subset and preoperative optimization of nutritional status may improve surgical outcomes.
Ascites ; Diet ; Female ; Genital Neoplasms, Female ; Humans ; Hypoalbuminemia* ; Length of Stay ; Medical Records ; Multivariate Analysis ; Nutritional Status ; Postoperative Complications ; Risk Factors* ; Serum Albumin

Purpose: A critical indicator of the overall survival of patients with high-grade glioma is the successful isolation of tumor mesenchymal stem-like cells (tMSLCs), which play important roles in glioma progression. However, attempts to isolate tMSLCs from surgical specimens have not always been successful, and the reasons for this remain unclear. Considering that the amount of surgical high-grade glioma specimens varies, we hypothesized that larger surgical specimens would be better for tMSLC isolation. Materials and Methods: We assessed 51 fresh, high-grade glioma specimens and divided them into two groups according to the success or failure of tMSLC isolation. The success of tMSLC isolation was confirmed by plastic adherence, presenting antigens, tri-lineage differentiation, and non-tumorigenicity. Differences in characteristics between the two groups were tested using independent two sample t-tests, chi-square tests, or Kaplan-Meier survival analysis. Results: The mean specimen weights of the groups differed from each other (tMSLC-negative group: 469.9±341.9 mg, tMSLC positive group: 546.7±618.9 mg), but the difference was not statistically significant. The optimal cut-off value of specimen weight was 180 mg, and the area under the curve value was 0.599. Conclusion Our results suggested a minimum criterion for specimen collection, and found that the specimen amount was not deeply related to tMSLC detection. Collectively, our findings imply that the ability to isolate tMSLCs is determined by factors other than the specimen amount.